The most widespread shortage identified in the new survey involves ifosfamide, a generic chemotherapy drug that 94 percent of responding centers reported as being in short supply. Ifosfamide is far from a niche product: it is a workhorse alkylating agent deployed in treatment regimens for bladder, ovarian, testicular, and uterine cancers, as well as soft tissue sarcoma, osteosarcoma, and several adult and pediatric leukemias and lymphomas. Its inclusion among pediatric and adolescent cancer protocols makes the shortage particularly consequential, because clinicians managing young patients with limited therapeutic alternatives have fewer options to substitute when a foundational drug becomes scarce. The breadth of ifosfamide’s use across tumor types means that a single manufacturing failure can touch nearly every subspecialty within a comprehensive cancer center at once, from sarcoma clinics to hematology wards.

Platinum-based chemotherapy agents, which form the backbone of curative and palliative regimens for numerous tumor types, are also under strain once again. Seventy-one percent of surveyed centers reported a current shortage of carboplatin, a striking return of the supply crisis that first drew national attention in 2023, while 16 percent reported shortages of cisplatin. These two drugs are among the most widely used cytotoxic agents in modern medicine, appearing in protocols for lung, ovarian, testicular, head and neck, and many other cancers. In addition, more than half of respondents reported ongoing shortages of Bacillus Calmette-Guérin, or BCG, the immunotherapy instilled directly into the bladder to treat non-muscle-invasive bladder cancer, a therapy for which there is no simple pharmacologic equivalent. The recurrence of carboplatin shortages, after an intense period of public attention and federal response in 2023, suggests that the underlying vulnerabilities in the generic injectable drug supply chain have not been resolved.

NCCN first began surveying its Member Institutions about drug shortages in June 2023, when an abrupt collapse in the supply of carboplatin and cisplatin, traced in part to quality problems at overseas manufacturing facilities, forced oncologists across the country to ration doses and delay treatments. The fact that the network has continued to measure the problem for more than three years provides a rare longitudinal view of a persistent public health failure. When the latest survey asked pharmacy directors whether national or state policies had made the shortage situation better or worse since 2023, only 4 percent said conditions had improved, while 96 percent felt the situation had stayed the same. That near-unanimous assessment of policy stagnation is perhaps the most politically significant finding in the dataset, indicating that legislative and regulatory efforts to date have not yet altered the economic dynamics that produce recurring shortages.

Crystal S. Denlinger, MD, Chief Executive Officer of NCCN, described the persistence of the problem as disheartening, noting that recurring or continued shortages of some drugs have continued despite years of raising the alarm and providing insight about what she characterized as a disruptive and dangerous issue for cancer care in America. Denlinger emphasized that the cancer centers in the network have developed internal strategies, task forces, and communications plans to keep patient care and clinical trials on track. The good news, she noted, is that those mechanisms exist; the bad news is that managing shortages consumes time and attention that could otherwise be spent improving patient experiences and outcomes, and it adds additional stress to an already burdened system. Her comments capture a paradox familiar to hospital pharmacists nationwide: the institutions best equipped to absorb supply shocks are also the ones expending enormous invisible labor to do so.

The operational toll of shortages is quantified elsewhere in the survey. Sixty-one percent of responding centers reported that they required pharmacy and physician-led mitigation strategies to keep all of their patients on a recommended dose and schedule. The majority of those centers implemented waste management strategies, which can include conserving vials, sharing partially used vials across patients under strict sterility protocols, and adjusting compounding practices to extract every usable dose from limited inventory. Others explored alternative recommended regimens, drawing on the NCCN Clinical Practice Guidelines in Oncology to identify evidence-based substitutions that preserve guideline-recommended care when a preferred agent is unavailable. These workarounds are clinically defensible, but they represent a continuous, resource-intensive improvisation that would be unnecessary in a functioning market.

When treatment plans did have to be modified because of shortages, 90 percent of centers reported a need for repeat prior authorization of the revised plan. That administrative requirement significantly increases the amount of work per patient and introduces the potential for delays in care continuity, since insurers must re-approve altered regimens before treatment can proceed. For patients, the consequence can be a gap between the decision to change therapy and the ability to actually receive it, a window in which aggressive cancers do not pause. For clinical staff, prior authorization rework compounds the pharmacy labor already consumed by shortage mitigation, illustrating how a supply chain failure upstream cascades into administrative burden downstream, multiplying the true cost of each shortage far beyond the price of the missing drug itself.

On the question of solutions, the survey revealed a strong consensus among pharmacy leadership. Alyssa Schatz, DrPh, MSW, Vice President of Policy and Advocacy at NCCN, noted that nearly every pharmacy director who responded would like to see economic incentives put in place to encourage high-quality manufacturing for generic cancer medications, something advocates have been requesting for years. One survey respondent summarized the core problem in stark terms: many oncology generics are clinically indispensable but economically unattractive, and without correcting that economic imbalance, shortages are likely to recur. The structural logic is well understood in health policy circles. Generic injectable drugs are cheap, which benefits payers and patients, but rock-bottom prices leave manufacturers with thin margins, little incentive to invest in quality infrastructure or redundancy, and every reason to exit the market when problems arise. The survey also illuminated a desire for better information about generic suppliers and for earlier notifications by manufacturers to the US Food and Drug Administration, which would give hospitals more lead time to prepare mitigation plans before shelves empty.

NCCN is part of the End Cancer Drug Shortages Coalition, a group that brings together more than a dozen hematology and oncology nonprofits to address the issue and propose long-term solutions. In May 2026, the coalition issued a consensus statement offering a big-picture assessment of the ongoing problem and a list of policy proposals for the future, ranging from payment and purchasing reforms to manufacturing quality incentives. The coalition’s work reflects a growing recognition among oncology professional societies that shortage response cannot remain the province of individual hospital task forces indefinitely, and that durable fixes must operate at the level of the market itself, where the pricing of essential generic medicines currently fails to reward reliability.

For patients and clinicians, the practical meaning of the 2026 survey is sobering: three years of advocacy, congressional hearings, and federal attention have produced internal resilience but not external change. Every comprehensive cancer center surveyed is still managing around at least one missing chemotherapy agent, and a substantial fraction is juggling five or more at once. The network’s findings, available through NCCN’s drug shortage resources, will continue to serve as a benchmark for measuring whether the economic incentives, supplier transparency measures, and early notification requirements that pharmacy leaders overwhelmingly support are eventually translated into policy. Until then, the quiet work of vial conservation, regimen substitution, and reauthorization paperwork will remain an unheralded but essential layer of cancer care in the United States, holding the system together one shortage at a time.

Subject of Research: Persistent generic cancer medication shortages reported by United States comprehensive cancer centers

Article Title: New NCCN survey highlights persistent cancer medication shortages across United States

Article References: New NCCN survey highlights persistent cancer medication shortages across United States. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: NCCN, drug shortages, cancer medication, ifosfamide, carboplatin, cisplatin, BCG, generic drugs, oncology, pharmacy, health policy, supply chain